Heart Disease, Birth Control, and Pregnancy

By the American Heart Association

Do you take birth control? Or are you pregnant or planning to become pregnant? Using some form of hormonal birth control and starting a family are important parts of many women’s life experiences. But both birth control and pregnancy can affect your heart health. This is especially true if you personally have a history of cardiovascular disease (CVD) or if it runs in your family.

The American Heart Association recommends speaking with your doctor or cardiologist about hormonal birth control if you suffer from CVD. You should also speak with your doctor before you become pregnant regarding your concerns about heart disease. Read on to learn more about the connection between birth control, pregnancy, and heart disease.

Pregnancy and Heart Disease

The American Heart Association recommends scheduling a prepregnancy evaluation with your primary care doctor and a cardiologist to discuss any concerns you may have about pregnancy and heart disease.

Women with repaired congenital heart disease can have a safe pregnancy with very little risk. But body changes during the second and third trimesters can cause an increase in symptoms, even for women without preexisting problems.

Here are a few tips to note before getting pregnant.

Talk to your doctor about your blood pressure meds. Book an appointment to discuss any blood pressure medications that you are currently taking. Medications such as angiotensin- converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) have been shown to be dangerous to mothers and babies during pregnancy because they can cause kidney failure, high potassium levels, and low blood pressure. Do not discontinue any medications, however, without first talking to your doctor.

Talk to your doctor about your form of heart disease. Some types of heart disease can pose such a high risk to the mother and baby that pregnancy is not recommended. These include severe heart failure, pulmonary hypertension, cyanosis, and Eisenmenger’s syndrome (the combination of cyanosis and pulmonary hypertension). If you currently have any of these conditions, talk to your cardiologist before getting pregnant.

Pay attention to your blood pressure. Blood pressure levels are incredibly important when it comes to pregnancy. If you have high blood pressure going into your pregnancy, talk to your doctor and devise a plan for lowering it through diet and exercise.

Once you have met with your doctor to understand all possible risks and issues related to heart health, it will be time to think about how to have the healthiest pregnancy possible. This will be an exciting time—a time to plan for the growth of your family, college funds, and nursery colors. It is also a time, according to Suzanne Steinbaum, DO, to take care of your body in heart-healthy ways.

Eating and Exercise

“Pregnancy is a time to go back to basics,” says Dr. Steinbaum, national spokesperson for Go Red For Women and author of Dr. Suzanne Steinbaum’s Heart Book: Every Woman’s Guide to a Heart- Healthy Life (Avery, 2013). “The healthiest diet we’ve seen is the Mediterranean-style diet, which is typically high in high-fiber whole grains, nuts, and omega-3 fatty acids from fish and olive oil.”

Dr. Steinbaum warns pregnant women to stay away from salt because it can increase their blood pressure and cause fluid retention. It is also a good idea to avoid caffeine because it can trigger irregular heartbeats, she says.

“Watch your diet and watch your weight; pregnancy doesn’t give you carte blanche to eat whatever you want,” she says. “Remember that you are trying to get nutrients to a growing fetus. Do you want your fetus to be growing on gummy bears? I don’t think so.”

Exercise is important during pregnancy because it can help you manage your weight. Women who are pregnant should be under the care of a healthcare provider with whom they can discuss how to adjust amounts of physical activity during pregnancy and the postpartum period. Unless a woman has medical reasons to avoid physical activity during pregnancy, she can begin or continue moderate-intensity aerobic activity during pregnancy and after the baby is born, suggests Dr. Steinbaum.

Women with Heart Disease What if you get pregnant after you have been diagnosed with heart disease or experienced a heart attack? In that case, Dr. Steinbaum recommends going to a high-risk obstetrics doctor and immediately alerting your cardiologist to your pregnancy. “If you have heart disease, you may be on medications that could be harmful to your baby,” she says. “Tell your doctors about your pregnancy right away and ask them about every medication you are on to make sure it won’t hurt your fetus.”

Reprinted with permission from the American Heart Association

Birth Control and Heart Disease

Women who have congenital heart disease are safe in using most forms of birth control, but before starting any medication regimen it is important to talk to your doctor about your specific concerns. The American Heart Association recommends consulting your primary care physician, gynecologist, and cardiologist before beginning birth control, just to be safe.

Birth Control Options

Progesterone-Only Birth Control. Depo-Provera® (depot medroxyprogesterone acetate, aka “the shot”), the mini pill, and Implanon® (birth control implant) are safe for women with heart disease, in most cases. It is important to note, however, that these forms of birth control may lead to fluid retention.

Intrauterine Devices. Intrauterine devices (IUDs) are T-shaped devices implanted in the uterus by a doctor to prevent pregnancy; they are also useful for women with heart disease. These types of birth control methods are recommended only for women in stable or monogamous relationships because they do not guard against sexually transmitted diseases.

Tubal Ligation. Tubal ligation, also referred to as “getting your tubes tied,” is a permanent sterilization procedure for women. This is safe for women with heart disease but is recommended only for those who no longer want to have children. It can be performed surgically or vaginally.

Birth Control and Blood Pressure

Doctors and researchers have found a link between birth control pills and an increase in blood pressure among some women. They say that it is more likely to occur in women who are already overweight, have kidney disease, or have a family history of high blood pressure.

Note that a combination of birth control pills and smoking can be very dangerous to women. Especially in younger women, the combination of birth control pills and smoking increases the risk of heart disease by a whopping 20 percent.

Worried about your blood pressure and how it relates to birth control usage? Consult your doctor before starting any medications and have your blood pressure levels checked every six months to make sure you are in a healthy range.

Learn more about birth control, pregnancy, and high blood pressure from the American Heart Association at heart.org.